Physician–patient communication in vascular surgery: Analysis of encounters in academic practice

Abstract

Objective: To assess physician–patient communication in vascular consults with the aim of identifying areas for improvement. Introduction: Shared decision-making in clinical consults can enhance patient outcomes. Its potential benefits are significant in vascular surgery, where decisions are dependent on the patient’s definition of quality of life and outcomes are influenced by significant lifestyle changes. Methods: In this qualitative cross-sectional study, encounters between five vascular surgeons and their patients with two asymptomatic vascular diseases were audio recorded, transcribed, and analyzed for validated sociolinguistic statistics. The nine-item shared decision-making questionnaire was used to gauge subjective patient perspective. Results: Physicians spent an average of 19 min and 28 s (±8:55) per consult and an average of 12 min and 7 s talking to the patient (±6:33). Physicians used formalized language about 10.3 times an encounter (±8.39), checked for understanding 6.4 times (±4.84), and asked more close-ended than open-ended questions (10.5 ± 6.15 versus 4.6 ± 2.37). Physicians accounted for 46.34% of utterances (±6%) and averaged 5.8 interruptions per encounter (±4). Patients and company accounted for 53.66% of total utterances (±6%) and averaged 10.1 clarification questions (±9.78). The average nine-item shared decision-making questionnaire Likert-type score per patient was 2.82 on a range of −3 to +3 (±0.33), with positive numbers indicating agreement. On average, patients strongly (+2) or completely (+3) agreed that physicians covered the nine criteria. Conclusion: The 9-item shared decision-making questionnaire data showed that patients mostly felt their physician was adequate in exhibiting shared decision-making behaviors. However, physicians asked closed-ended questions that elicited “yes/no” or brief responses, continuously interrupted patient narratives, and rarely checked for understanding from their patients. These subliminal behaviors restrict patient participation in shared decision-making and may be corrected via longitudinal intervention.